Monica A. Fisher

Bidirectional relationship between chronic kidney and periodontal disease: a study using structural equation modeling

Periodontal disease is associated with diabetes, heart disease, and chronic kidney disease (CKD), relationships postulated to be due in part to vascular inflammation. A bidirectional relationship between CKD and periodontal disease is plausible, though this relationship has not been previously reported. In this study, we assessed the potential for connections between CKD and periodontal disease, and mediators of these relationships using structural equation models of data from 11,211 adults ≥ 18 years of age who participated in the Third National Health and Nutrition Examination Survey. Multivariable logistic regression models were used to test the hypothesis that periodontal disease was independently associated with CKD. Given the potential that the periodontal disease and CKD relationship may be bidirectional, a two-step analytic approach was used that involved tests for mediation and structural equation models to examine more complex direct and indirect effects of periodontal disease on CKD, and vice versa. In two separate models, periodontal disease (adjusted odds ratio of 1.62), edentulism (adjusted odds ratio of 1.83), and the periodontal disease score were associated with CKD when simultaneously adjusting for 14 other factors. Altogether, three of four structural equation models support the hypothesized relationship. Thus, our analyses support a bidirectional relationship between CKD and periodontal disease, mediated by hypertension and the duration of diabetes.

Pretreatment characteristics associated with orthodontic treatment duration

INTRODUCTION Pretreatment characteristics can assist orthodontists in accurately estimating treatment duration. METHODS This case-control study identified 400 patients, 9 to 18 years of age. Short treatment duration was 20 months or less, and long treatment duration was 30 months or longer. Potential pretreatment explanatory variables included planned treatment, sociodemographic, behavior, dental, skeletal, and soft-tissue characteristics. Univariable and multivariable logistic regression modeling was used to quantify the association between patient characteristics and treatment duration by reporting the unadjusted odds ratios (ORcrude), the adjusted odds ratios (ORadj), and the 95% confidence intervals (CIs). RESULTS Patients planned as nonextraction (ORadj = 2.3; 95% CI, 1.3-4.2), no deciduous teeth (ORadj = 3.0; 95% CI, 1.5-5.9), less than 80% overbite (ORadj = 2.4; 95% CI, 1.3-4.4), less than 6 mm of maxillary crowding (ORadj = 3.6; 95% CI, 1.7-7.7), and good oral hygiene (ORadj = 3.2; 95% CI, 1.3-1.8) were 2 to 3 times more likely to have short treatments. Patients with decreased lower facial height (ORadj = 3.4; 95% CI, 1.6-7.1), extractions (ORadj = 1.8; 95% CI, 1.0-3.2), deciduous teeth (ORadj = 1.9; 95% CI, 1.0-3.4), poor grades (ORadj = 2.0; 95% CI, 1.1-3.8), excessive overjet (ORadj = 2.3; 95% CI, 1.4-3.8), 80% or more overbite (ORadj = 2.0; 95% CI,1.2-3.6), and 6 mm or more of maxillary crowding (ORadj = 2.6; 95% CI,1.4-4.6) were 2 to 3 times more likely to have long treatments. CONCLUSIONS Presence or absence of severe maxillary crowding, deciduous teeth, 80% overbite, and extractions were consistently, inversely, and independently associated with short and long treatment durations.

Age and Race/Ethnicity-Gender Predictors of Denying Smoking, United States

Smoking is a major risk factor for many chronic diseases. Nearly all studies collecting smoking data use self-reports, which are very rarely validated. We identified 15,182 adults 18 years or older in the Third National Health and Nutrition Examination Survey. Denying smoking, the main outcome, was defined as cotinine-determined smokers self-reporting non-smoking. Multiple logistic regression modeling took into account the complex survey design and sample weights. Age and race/ethnicity-gender categories predicted denying smoking. Smokers denying smoking ranged from 0.0% for elderly (75 years and older) Mexican-American women to 67.8% for elderly non-Hispanic Black women. Among elderly smokers, non-Hispanic Black women were more likely to deny smoking than both non-Hispanic White women (odds ratio (OR) = 8.9, 95% confidence interval (CI): 2.1–38.3) and non-Hispanic Black men (OR=21.4 95% CI: 4.3–107.2). This U.S. population-based study of age-specific race/ethnicity-gender predictors of denying smoking suggests caution in interpreting smoking-related survey data.

The association between Medicaid status and broken orthodontic appointments is not clearly established.

Article Title and Bibliographic Information Appointment keeping behavior of Medicaid vs non-Medicaid orthodontic patients. Horsley BP, Lindauer SJ, Shroff B, Tufekci E, Abubaker AO, Fowler CE, Maxfield BJ. Am J Orthod Dentofacial Orthop 2007;132: 49-53. Level of Evidence Level 3 (Other evidence) Strength of Recommendation Grade Not applicable Purpose/Question To determine if differences exist in the rates of broken appointments between Medicaid and non-Medicaid orthodontic patients. Source Of Funding Medical College of Virginia Orthodontic Education and Research Foundation. Type Of Study/Design Cross-sectional study

Prevalence of Gingival Overgrowth in Renal Transplant Recipients on Sirolimus Immunosuppressive Therapy is not Clearly Established

PURPOSE/QUESTION The authors attempted to study the gingival status of renal transplant patients receiving sirolimus immunosuppressive therapy by measuring the presence and severity of gingival overgrowth (GO) and by investigating the association between GO and sociodemographic, medical, and pharmacologic variables. SOURCE OF FUNDING Grants from the Coordination of Improvement of Upper Level Personnel (CAPES), Brasilia, DF, Brazil, and the Foundation for Support of Research in Minas Gerais (FAPEMIG/#13016). TYPE OF STUDY/DESIGN Cross-sectional LEVEL OF EVIDENCE Level 3: Other evidence. STRENGTH OF RECOMMENDATION GRADE Not applicable.

North Carolina Orthodontists' Medicaid Provider Status is Associated with Perception of Major Problems with Medicaid

Article Title and Bibliographic Information The North Carolina Medicaid program: participation and perceptions among practicing orthodontists. Im JL, Phillips C, Lee J, Beane R. Am J Orthod Dentofacial Orthop 2007;132: 144.e15-148.e21. Level of Evidence Level 3: Other evidence. Strength of Recommendation Grade Not applicable. Purpose/Question To determine North Carolina orthodontists’ level of participation in Medicaid, their perceptions of Medicaid and its beneficiaries, and whether there are any differences between practitioners who do and do not accept new Medicaid patients. Source of Funding Supported in part by the US government, NIH grant R01 DE005215 “Influences on Stability Following Orthognathic Surgery”. No information was provided by the authors regarding the other support. Type of Study/Design Cross-sectional study.

North Carolina orthodontists' Medicaid provider status is associated with perceived problems with Medicaid.

Article Title and Bibliographic Information Im JL, Phillips C, Lee J, Beane R. The North Carolina Medicaid program: participation and perceptions among practicing orthodontists. Am J Orthod Dentofacial Orthop 2007;132:144.e15-8.e21. Level of Evidence Level 3: Other evidence. Strength of Recommendation Grade Not applicable. Purpose/Question To determine North Carolina orthodontists’ level of participation in Medicaid, their perceptions of Medicaid and its beneficiaries, and whether there are any differences between practitioners who do and do not accept new Medicaid patients. Source of Funding Supported in part by the US government, NIH grant R01 DE005215 “Influences on Stability Following Orthognathic Surgery.” No information was provided by the authors regarding the other support. Type of Study/Design Cross-sectional study.